Postpartum Hemorrhage PPH

Postpartum Hemorrhage PPH
Any amount of bleeding following after birth hoti ek of puerperium
Systolic blood pressure decrease=70mmHg
Plus rate=122B/min
After delivery 
1) Mild PPH
 500 to 1000ml blood loss
2) Moderate PPH
1000 to 2000ml blood loss
3) Severe PPH
Greater than 2000ml blood loss
According to duration of bleeding=
1) primary PPH
Bleeding within 24 hour's of delivery
a) 3rd stage PPH
Bleeding after delivery and before expulsion of placenta
b) True PPH
Bleeding after expulsion of placenta and hoti 24 hour's
2) Secondary PPH
24 hour's to end of puerperium
Bleeding arround to 8days
PPH is a bleeding cause of materanl mortality rate MMR 28week to 7dya after birth
Cause of PPH
1) Atonic uterus/Boggy uterus 
Uterine tone absent
Multiple pregnancy
Grand multi para
Malnutrition female
Over distension of uterus
Anesthesia effects
Prolonged labour
2) Traumatic uterus
Firm urterus,hard , tenderness
Bleeding due to instrumental and forceps delivery =trouma and genital tract
Sign and symptoms
Uterus soft /nontenderness
Atonic uterus 
Hard and firm , tenderness
Traumatic uterus
Bleeding
Blood pressure decrease systolic
Plus rate increase
Managment=
1) Hospitals
Iv fluid start
Blood transfusion if needed
Oxygen administration if needed
a)Placenta separated
Fundal pressure and contorlle cord traction remove
b)Placenta not separated
Manual remove under general anesthesia
Iv oxytocin with 500ml NS and 20IU
At the rate 60drop/minutes or 4ml/minutes
Uterine artery compressed then bleeding
2) True PPH
Hospitals
Iv fluid start
Vital sign chek
Blood transfusion
Oxygen administration
Uterin massage
Iv oxytocin and Ergometrine 0.5mg and methergin0.25mg
Bleeding continue
Misolrotol 1000
Bleeding continue
Uterine temponade/manually compression
Tight packing of gential track with Goazpiuece
Bleeding continue
Uterin artery ligate
Bleeding continue
Hysterectomy
3) Second stage PPH of management
Retain bits of placenta
Infection and irritation bleeding
Exploration of gential tract and remove the part of placenta
Ergometrine and methergin and foot elevated position...



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